title: Early results of an objective feedback-directed system for the staged traction repair of long-gap esophageal atresia.
abstract: OBJECTIVE
  Treatment of long-gap esophageal atresia challenges pediatric surgeons. Dr. Foker described utilization of external traction sutures to promote in-vivo growth through tension-induced lengthening, but reproducibility of this technique is difficult. We describe a safe and reproducible traction system using transduction of hydrostatic pressure as a surrogate for tension.
  
  
  METHODS
  We conducted a multi-institutional review of patients treated with this system from 2005 to 2012. All children had sutures applied to both pouches with continuous measurement of associated hydrostatic pressures (tension). Main outcome measures were days to delayed primary repair and thoracotomies prior to primary repair.
  
  
  RESULTS
  Seven children were included. Median time to delayed repair was 15 days (range: 6-47 days). Three patients required repeat thoracotomies owing to mechanical entrapment of a pouch, all identified early by this system. All required postoperative dilations. Three had self-limited postdilation leaks, and there was one operation-related leak.
  
  
  CONCLUSIONS
  This system provides reproducible traction application, facilitating staged primary repair by preventing major failures through limiting excessive traction and guides re-exploration for trapped segments. Larger studies are needed to determine the optimal tension protocol, prevent postoperative leaks, while decreasing the need for dilations and time to enteral feeding.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.forename: Robert
authors.initials: R
authors.lastname: Ricca
authors.forename: Kimberly
authors.initials: K
authors.lastname: Riehle
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Saites
authors.forename: Chueh
authors.initials: C
authors.lastname: Lien
authors.forename: Glen F
authors.initials: GF
authors.lastname: Anderson
authors.forename: David C
authors.initials: DC
authors.lastname: Wahoff
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Linden
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D001696:Biomechanical Phenomena; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy; D014143:Traction / Q000379:methods*
keywords: Biomechanical stress; Esophageal lengthening; Long gap esophageal atresia (LGEA); Tension